At Frontline Hospital, Afghan War's Toll Is Deeply Felt

By Brian Mockenhaupt

As
fighting season begins in Afghanistan, the Kandahar Airfield hospital
will likely triple its trauma cases.

Peter Andrews/Reuters

KANDAHAR,
Afghanistan -- By 7 a.m., the first patients of the day were slid off
the medevac helicopters and wheeled into the trauma bay at the Kandahar
Airfield hospital in southern Afghanistan.

"I've got a wedding
ring. Make sure my wife gets it," Staff Sergeant Jeremy Breece said. His
face was streaked black and green with camouflage paint, and smeared
with dirt from the explosion. "I need to call her and let her know I'm
okay." A tourniquet squeezed each thigh. His legs ended just below the
knees, still covered in shredded pantleg. The trauma team -- a doctor,
two nurses, and two Navy corpsmen -- cut away his uniform and checked
for other wounds

"How's Pops?" Breece asked, before a nurse sedated him.

Specialist
Adam "Pops" Castagna, one of the oldest in the platoon at 37, had been
walking just behind and to the left of Breece when the blast hit his
torso and face. Now he lay on a gurney eight feet from Breece, groaning.
"I can't breathe," he said. "My stomach is killing me." Though he had no
visible injuries other than cuts on his face, an ultrasound showed
blood filling his abdominal cavity. The explosive force had ruptured
several organs. Fifteen minutes after arriving at the hospital, Castagna
was wheeled into the operating room, where surgeons sliced open his
abdomen and searched for source of the bleeding.

Thirty minutes later,
Breece entered a neighboring operating room. Surgeons tied off blood
vessels and cut away torn and shattered skin, muscle, and bone. They
cleaned out dirt and shrapnel from his flesh and muscle and then sewed
his legs shut.

For the hospital staff, a mix of Americans,
Canadians, Dutch, Belgians, Australians, and French, such injuries are
common fare, and their frequency is increasing. From the slow winter
months to the height of summer fighting season, daily trauma cases
typically triple between January and July. Military leaders expect the same
this summer as the Taliban fight to reassert control over areas where
coalition forces made significant gains over the past year, and to
retain areas where they still hold sway. The steady climb in casualties
has already begun. The hospital, just one of many NATO medical
facilities across Afghanistan, saw in a single April day: gunshot wound;
IED; gunshot wound; IED; IED (two victims); suicide bomber (six
victims); IED.

The cases are often more complex than those seen
in civilian trauma centers in the U.S. Here, a single patient could have
multiple amputations, shrapnel wounds, burns, internal bleeding from
concussive force, and a brain injury. But survivability is high, in
large part because of the fast and frequent use of tourniquets in the
field. Once considered a last resort, as the loss of circulation can kill limbs if tourniquets are left on too long, they are now cranked onto arms and legs immediately, and helicopter medevacs can have patients at the hospital within a half hour of injury. Of those
brought into the Kandahar Airfield trauma bay, 97 percent live.

Which leaves the 3 percent.

Two
days before Breece and Castagna were brought in, the doctors, nurses,
and corpsmen stood at attention and saluted as a flag-draped body bag
was wheeled outside and loaded into a van bound for the mortuary. The
soldier had arrived with a channel carved through his brain by a bullet
that had entered his right temple and exited the left. His brain
swelled, squeezed the brain stem, and stopped his heart. The staff
watched in silence as his life ebbed. They had dealt with this before,
patients too far gone, and knew they would again. "You feel like you
weren't even given the chance to give them a chance," Lieutenant
Commander Ron Bolen, the trauma-bay department head, said afterward.

Coalition
soldiers, mostly Americans, comprise half the patients. The majority
stay in Kandahar less than 48 hours before making their way to home
countries. Americans are flown to Bagram Airfield outside Kabul, then to
Landstuhl Regional Medical Center in Germany. Those with lesser wounds
recuperate there and return to duty in Afghanistan; the rest continue on
to military hospitals in the U.S.

Afghan patients stay at the
Kandahar Airfield hospital longer, often for weeks, until they are well
enough to be transferred to local facilities, where the care is earnest
but decades behind. The Afghans are evenly split between security forces
and civilians, with the occasional insurgent. Of the civilians, half
are children, a surprise to many hospital staff who arrived here
assuming they would mostly treat wounded soldiers. Some have been hurt
in car wrecks and falls, but many are battle casualties, like the2 -year-old boy hit in the left arm with a bullet, now asleep in a tiny
wheelchair, a blanket across his lap. Or the brothers, 3 and 6,
peppered with shrapnel, resting on adjoining beds. Or, in the back
corner of the intensive-care unit, a boy, 7, whimpering softly as a
nurse changes his dressings. An IED tore open his stomach, took off his
left leg below the knee, and killed his four playmates.

At 10
a.m., after an hour and a half of surgery, Breece joined the little boy
in the ICU. Nurses parked his gurney next to an unconscious Afghan
special-forces soldier whose body bore dozens of shrapnel wounds. They
pulled out the plastic breathing tube that had been snaked down Breece's
throat before surgery. The camouflage paint and dirt had been wiped
from his face. His chest and arms were bare. A white blanket covered
the lower half of his body, and went flat just past his knees.

He slowly awoke from the anesthesia. Even in the haze, he understood what had happened.

"Do you feel up to seeing some of your buddies?" his ICU nurse, Commander Thomas Shu, asked.

Seven soldiers from the Germany-based Second Stryker Cavalry Regiment crowded around his bed.

"You'll be back in Germany drinking beer in no time," Staff Sergeant Jeremy Bennett said. He held Breece's left hand, cut in the explosion and wrapped in thick bandages.

Not allowed to drink water until the anesthesia wore off, Breece sucked on a moistened sponge.

"Do
you know where you are?" Lieutenant Colonel Michaele McCulley asked
him. She meets all of the regiment's injured troops at the hospital and
sees them through the first hours of their injuries. With more than 100
soldiers wounded during the deployment, she had been here many times.
"They took you to surgery to repair and close up those wounds."

"Do I have knees?" Breece asked.

"You have both knees," McCulley said.

"So I'm good now? I'm living?"

In
the trauma bay, the staff cleaned up bloody bandages, replaced
supplies, and waited for the war to deliver more wounded. Their next two
patients had been shot with a burst of machine-gun fire as they searched a
dirt road for bombs in Zhari district, west of Kandahar City. Private
Second Class Scotty Hasting was hit in the right shoulder and left hip.
Sergeant Jacob Manninen was shot in the left forearm.

In the
operating room, surgeons removed Castagna's spleen and stanched the
bleeding in his abdomen. Nurses wheeled him into the ICU, a few beds
from Breece. He was still under sedation. A machine breathed for him.

"How do you like that?" Breece said. "Last patrol. One week to go home."

His
platoon had been dropped off by helicopter at six that morning in a
remote stretch of Panjwai district for its last mission, a daylong
clearing operation. On the outskirts of a village a half hour later,
Breece crossed a break in a wall. "We push through it and that's it. The
next thing I know I'm upside down in the air," Breece told the gathered
soldiers. "No legs, man."

McCulley stroked his forehead.

A
general would visit several hours later to present Purple Heart medals
to Breece, Castagna, Manninen, and Hasting. All but Manninen, who would return to duty after his wounds healed, would leave
Afghanistan the next day.

Breece marveled again at his bad luck. "One week left," he said. "Pretty wild man. Freakin' wild. I'm just happy to be here."

"Do you want to call your wife now?" McCulley asked.

He nodded slightly, eyes still cloudy with anesthesia. "She needs to know," he said.

"Do
you want to talk about what you're going to say?" McCulley asked. "It's
a hard call to make. She's going to panic and probably cry."